Our health system is built on an antiquated model of care


A new report shows that people with behavioral and physical health conditions drive up total health care costs; however, spending on behavioral health treatment is only a small portion of total health care spending. Not surprising, given that the U.S. health care system still fails to acknowledge the brain as an essential part of the body. 

Here is a common scenario: A woman with chronic heartburn seeks medical help. She is prescribed medication, but it can’t be taken long term. When her symptoms return, the woman sees a specialist and undergoes an endoscopy. The results come back normal, yet symptoms persist. The woman then enters a cycle of further testing that continues for months, when, in reality, an untreated mental health disorder called Generalized Anxiety Disorder (GAD) is largely to blame. Had she been screened for GAD, the medical costs generated by invasive procedures may have been avoided.

This is just one small example of how a collective failure to embrace brain health drives up health care costs. Others can be far more serious and costly. For example, depression is considered a major contributor to heart disease and diabetes, but it is rarely addressed as such in medical settings. According to the CDC, people experiencing depression, anxiety, stress, and PTSD over a long period of time may experience harmful effects including increased heart rate, blood pressure, and cortisol levels. Additionally, negative lifestyle habits associated with depression, such as smoking, excessive alcohol consumption, lack of exercise, poor diet and lack of social support, can increase heart disease and diabetes risk. 

When underlying factors such as anxiety and depression go unaddressed, people typically require substantially more care. The aforementioned report, conducted by Milliman, Inc., supports this. Of the 21 million people studied, 27% had a behavioral health condition. These individuals made up 56% of total health care costs and their expenses were 2.8 to 6.2 times higher (depending on the condition) than those of people without a behavioral health condition. Additionally, 5.7% of the entire study population—high-cost patients with both behavioral and physical health conditions—accounted for 44% of all health care spending. 

Conversely, when people with behavioral and physical health conditions are identified early and treated with evidence-based behavioral treatment, improved outcomes and substantial savings are achievable. But prioritizing integrated care —where the brain is treated alongside the body — isn’t as easy as flipping a switch. Our medical professionals must be trained to screen for common conditions and work in conjunction with mental health and addiction treatment providers. Insurers must reimburse providers fairly to maintain diverse networks. Our hospital systems must rebuild antiquated infrastructures to include collaborative care. And policymakers must introduce and support legislation to fund these efforts. 

The COVID-19 pandemic has made the need for such systemic change even more urgent. Recently, more than 72,000 people who completed an online screening from Mental Health America indicated moderate to severe symptoms of depression, more than 39,000 had moderate to severe symptoms of anxiety, and more than 19,000 had symptoms of psychosis— the highest numbers the organization has ever recorded. 

 This will likely manifest in increased medical spending down the road if not addressed. While the Milliman report did not study the effect of COVID-19 on behavioral health, its analysis of 2017 claims data does provide a baseline for estimating the potential impact of the pandemic on the treatment of behavioral health conditions and medical spending. Advocates will be watching. But in the meantime, families across the country can attest to how mental health and addiction impact physical health. So many feel helpless, unable to swim upstream in a health care system that is not designed for practicing prevention. There is an old African proverb that says if you want to save people from drowning, make sure they don’t fall in. 

Individuals from all walks of life have been traumatized by isolation, grief, and unemployment stemming from COVID-19. But one thing that often comes from trauma recovery is a new perspective — the ability to take stock of one’s life and make changes. The U.S. health care system is in great need of such a course correction. As the Milliman report points out, a fundamental principle of adequate health care is early detection and, in most circumstances, prompt treatment of identified health risks. 

We have a lot of work to do to get there, but let’s not squander this unique opportunity to evolve a critical system that impacts the lives of every American. It’s time to embrace mental health as essential health once and for all. 

Former U.S. Rep. Patrick J. Kennedy (D-R.I.) is founder of The Kennedy Forum, co-chair of the Action Alliance’s Mental Health & Suicide Prevention National Response to COVID-19, a former member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, and author of “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”

Tags Anxiety disorder Generalized anxiety disorder Health care in the United States Health in the United States Mental health Primary care

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